ECE2014 Poster Presentations Neuroendocrinology (27 abstracts)
Copeptin levels measured after pituitary surgery predict later development of diabetes insipidus
Bettina Winzeler 1 , Nicole Nigro 1 , Christian Zweifel 1, , Birsen Arici 1, , Martina Bally 2 , Claudine Blum 1 , Christopher Kelly 1 , Luigi Mariani 1 , Hans Landolt 2 , Philipp Schuetz 2 , Beat Mueller 2 & Mirjam Christ-Crain 1
1University Hospital Basel, Departments of Endocrinology and Neurosurgery, Basel, Switzerland, 2Department of Endocrinology, Medical University Clinic and Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland, 3Toronto Western Hospital, Division of Neurosurgery, Toronto, Canada.
Introduction: Postoperative diabetes insipidus (DI) remains a common complication after pituitary surgery. AVP measurement might contribute to a straightforward diagnosis, though, its measurement is cumbersome. Copeptin, the stable C-terminal glycopeptide of the AVP prohormone, is a reliable surrogate of AVP.
We aimed to elucidate whether copeptin is a helpful marker in the diagnostic approach of postoperative DI.
Methods/design: Prospective observational study in three tertiary referral centres in Switzerland and Canada. Patients undergoing pituitary surgery were daily monitored for clinical items (i.e. balance of fluids) and routine laboratory parameters. Copeptin levels were measured pre- and daily postoperatively until discharge. We also recorded tumour specific features and intraoperative manipulation of the neurohypophysis.
Results: Of the 205 patients included (mean age 53 years, 55.6% female) 50 (24.4%) developed postoperative DI, 155 patients had an uneventful postoperative course or developed SIADH (5.4%). The median copeptin levels measured preoperatively were 3.6 pM (IQR 2.4, 5.7) and increased more than two-fold to 8.4 pM (IQR 3.9, 22.6) after surgery. Copeptin levels of patients developing DI did not increase during surgery-induced stress and were lower postoperatively compared to patients without DI (median (IQR) 2.9 pM (1.9, 7.9) vs 10.8 pM (5.2, 30.4), P<0.001). This was most pronounced in a subset of 157 patients with early (<12 h) postoperative copeptin measurement (median (IQR) 2.9 pM (1.8, 10.3) vs 17.0 pM (7.6, 39.1), P<0.001).In patients with postoperative copeptin values <2.5 pM the positive predictive value for development of DI was 81% (specificity 97%). Conversely, if copeptin increased to levels >20 or >30 pM, negative predictive values and sensitivities were 93%/95% and 95%/98%.
Conclusion: Low postoperative copeptin levels despite surgery-induced stress indicate later DI. Copeptin may become a novel tool in the management of patients after pituitary surgery.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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